35/m 1 pack a day smoker off an on

Patient

Q: 35/m. 1 pack a day smoker off an on for 18 years - probably 10 years total smoking time.

I have a left sided neck mass. At least 2cm, hard, fixed, and moves up and down when I swallow. I noticed it about 5 months ago, and it started out small and hard to find, but now is bigger and easily felt. It has gotten slightly painful over the last few month and i feel like my throat is sore at times and have some ear pain on that side as well.

My doctor cant seem to feel it for some reason, and has put twice on my notes "not palpable". I had a neck ultrasound and the result was "21mm x 11mm elongated neck mass. Thyroid ok. Possible lymph node." I did 10 days of Keflex with no change.

Its almost exactly at the level of my adams apple. Would being fixed and moving when I swallow suggest a possible thyroid mass even though the doctor that read the ultrasound said thyroid ok? Could it be a lymph node? My doctor is not concerned at all about, but it has me worried. Thanks for any advice or insight!

Symptoms:  Neck mass. Occasional sore throat. No infection. Ear pain.
Doctor

A:   Thank you for choosing Ask The Doctor,

I have read your whole history and before I go into the depth of it, I want to summarise it:
You have been smoking for 17 years on and off and that is about 10 pack years. 10 years of smoking 1 pack daily is 10 pack years.
You have a neck mass that's not thyroid related
You have been given an antibiotic that did not work

Here is what your Doctor was thinking:
First, he thought that you had a thyroid lump. That was negative. Then next thing he thought is that you have an infection because of the sore throat and the ear pain (ear infection or throat infection) and he gave you antibiotics. But without a fever which I do not think you have an infection or at least one that can be treated with the antibiotic.

The next best step is to biopsy the lymph node or the swelling under Ultrasound. And then send it to pathology to get it checked. This will help to reach the diagnosis. This way, you will know what to deal with.

Once you have those reports I can help you with the diagnosis or confirm it.

A few diseases I would go for:
Resistant bacterial infection
Tuberculosis
Some systemic disease like autoimmune disorders
Some type of tumor
And least likely to be cancer

Do not worry and deal with this in a systematic way. Do ask if you have queries.

Wishing you the best of health. And please stop smoking right away. All the best.

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